Provider Demographics
NPI:1750563276
Name:FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-880-9710
Mailing Address - Street 1:PO BOX 11220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-1220
Mailing Address - Country:US
Mailing Address - Phone:281-880-9710
Mailing Address - Fax:281-880-9711
Practice Address - Street 1:17203 RED OAK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2640
Practice Address - Country:US
Practice Address - Phone:281-880-9710
Practice Address - Fax:281-880-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9230302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042969802Medicaid
TXTXB110824OtherMEDICARE GROUP PTAN
TX8AJ811OtherB/C B/S OF TEXAS
TX8AJ811OtherB/C B/S OF TEXAS
TX00615QMedicare PIN